By Pamela Douglas, MD

This article originally appeared in the April 1, 2007, edition of the News & Observer (Raleigh, NC).

Pop culture suggests that men are from Mars and women from Venus, but communication differences aren’t the only gap between the sexes. It turns out that men and women are very different when it comes down to health, too.

Historically, medical research has focused largely on men. Evaluations of new drug therapies and devices, such as implantable cardiac defibrillators, have included far more men than women.

Unfortunately, we cannot extrapolate findings from studies of men and assume that the results would also hold true for women. Yet that is exactly what has been done with some of the most commonly used procedures, devices and drugs.

Women and men are biologically and genetically different from one another. Women are smaller, and differences in genetics and hormonal complexity may influence how men and women develop certain diseases, process medications and even how they recover from surgery. This is particularly striking when it comes to heart disease.

Cardiovascular disease is different in women. Women, typically, are diagnosed five to 10 years later than men, and their symptoms tend to be less specific. Although the risk factors for developing heart disease are virtually the same for men and women older than 50, there is a notable exception: diabetes. Women with diabetes have three to five times the likelihood of developing heart disease as men.

Women with heart disease fare worse than men do, which makes prevention so important.

More women die each year following a heart attack than do men. We don’t know why, but there are some troubling clues. Women are less likely to be referred for cardiovascular procedures than are men, and they are less likely to be prescribed proven therapies such as aspirin therapy or beta-blockers after leaving the hospital.

Only one-third of women with high cholesterol levels are prescribed cholesterol-lowering medications, and only about 35 percent of women with high blood pressure have it under control.

And yet, high cholesterol levels and high blood pressure are two of the leading risk factors for developing heart disease.

Sadly, although heart disease kills 10 times more women older than 50 than breast cancer, there is far less awareness among women that this is one of their greatest health risks.

Although more women are being recruited into medical trials than ever before, the proportion of women to men in most trials is still too small to generate meaningful enough data to prove that what we are testing, and will soon be prescribing, is both safe and effective for women.

Much more attention is being paid toward gaining a greater understanding of the influence of sex on health problems such as cardiovascular disease.

Including more women in clinical trial research is both enlightening and empowering. It is long overdue.

The path to true medical wisdom is ensuring that both men and women are properly represented in medical studies, and cardiologists at Duke are among the national leaders voicing this belief. This is the only way to guarantee the most effective medical solutions are right for everyone.

-- Pamela S. Douglas, MD, is chief of Duke's Division of Cardiology.